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Top medical innovations address headache, diabetes, cancer

An Autonomic Technologies Inc. (ATI) Neurostimulator is pictured in this handout photo (Reuters).

By Debra Sherman

The best medical innovations for next year include an almond-size device that’s implanted in the mouth to relieve severe headaches and a hand-held scanner resembling a blow dryer that detects skin cancer, the Cleveland Clinic said on Wednesday.

But leading the 2013 list for innovations is an old procedure that has a new use due to findings in a recent study. Physicians and researchers at the clinic voted weight-loss surgery as the top medical innovation, not for its effectiveness in reducing obesity, but for its ability to control Type 2 diabetes, the most common form of the disease.

Over the years, bariatric surgeons noticed that the procedure would often rid obese patients of Type 2 diabetes, before they even left the hospital.

A study, led by Cleveland Clinic head of Bariatric and Metabolic Institute Dr. Philip Schauer, examining this phenomenon was published in the prestigious New England Journal of Medicine earlier this year.

“Bariatric surgery has been around for a while. The reason it was chosen as the top innovation is because Medicare has broadened its indication for payment, and Medicaid in many states follows Medicare. A lot of the other (private) insurance companies started covering it, so it’s much more accessible,” Dr. Michael Roizen, the Cleveland Clinic’s Chief Wellness Officer, said in an interview.

The criteria that insurers use to cover the surgery has been broadened because of its effectiveness in controlling Type 2 diabetes, he said.

The number of people affected by diabetes has tripled over the past 30 years to more than 20 million Americans, according to the Centers for Disease Control and Prevention, and more than 90 per cent of those cases are Type 2.

Doctors and researchers at the Cleveland Clinic voted for what they thought were the biggest, most significant innovations from the 250 ideas submitted from their colleagues at the clinic. Roizen said one of the main contributing factors to getting on the list is the number of people that the product or procedure can potentially help.

For that reason, a device that helps relieve headaches, the second most common ailment after the cold, was second on the clinic’s list.

The miniaturized device — invented at the Cleveland Clinic and spun off into a separate, private company called Autonomic Technologies Inc — is implanted in the upper gum above the second molar to treat cluster headaches and migraine headaches. A lead tip of the implant is placed near specific nerves behind the bridge of the nose.

When the patient feels the headache coming on, a remote control device is placed on the outside of the cheek and the device delivers stimulation to those nerves, blocking headache pain.

The implant is available in Europe, but not in the United States. The company needs to do more studies to get FDA approval, said Dr. Frank Papay, Department Chair of Dermatology and Plastic Surgery Institute at the Cleveland Clinic, and consultant to Autonomic Technologies.

A hand-held device used to detect melanoma, the most deadly form of skin cancer, was also on the list.

“Up until now, we’ve counted on our eyes,” Dr. Allison Vidimos, Department Chair of Dermatology at the Cleveland Clinic, told Reuters. “This device offers an objective look underneath the skin using a special spectrum of light.”

It compares moles and other things it finds on the patient’s skin with a large database containing information on all types of melanoma. It also rates the risk.

“All dermatologists fear missing melanomas. The cure rate can be close to 100 per cent if caught early,” she said.

Vidimos said using the device, approved by FDA last year for use by trained dermatologists, helps prevent unnecessary biopsies.

Mela Sciences Inc make the scanning device.

Also on the list is a new type of mammography, called breast tomosynthesis. This technology provides greater detail of the image than the standard mammography, which renders a 2-dimensional image.

For the patient, it may seem like there’s no difference. “You still have the squish,” said Dr. Alice Rim, Section Head of Diagnostic Radiology. But the images produced by the new technology show the breast in slices, so far more detail can be seen.

“With 2-demensional mammography, there are shadows, so it can be like a polar bear running around in a snow storm. This eliminates the shadows, allowing increased detection and fewer call backs (for a second mammography),” Rim said.

Other devices that made the list include mass spectrometry for bacterial infections, which allow microbiology laboratories to identify the type of bacteria sooner and with more specificity, a new modular stent graft to treat complex aortic aneurysm and a laser used for cataract surgery.

Novel drugs to treat advanced prostate cancer were on the clinic’s list because of their ability to halt the progress of the disease by blocking testosterone receptors.

A new technique to repair and regenerate damaged lungs, called ex vivo lung perfusion, is on the list. Experts say as many as 40 per cent of previously rejected donor lungs may now be suitable for transplantation after undergoing this novel “lung washing”.

The procedure involves placing donor lungs into a bubble-like chamber connected to a cardiopulmonary pump and ventilator. Over four to six hours, the lungs are repaired as special fluids are forced through the blood vessels. Nutrients are used to recondition the lungs as they inflate and deflate.

The final item on the list is neither a procedure, a drug nor a device, but healthcare programs that use incentives to encourage people to take better care of themselves.

“We are seeing efforts to avoid rationing of healthcare and seeing programs with incentives built in if people maintain their health. This can radically change the cost of care,” said Roizen. “We’re seeing this more in big companies, the GE’s and J&J’s of the world. All companies are looking at how much they are spending on healthcare and they are looking at ways they can reduce spending without rationing.”

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